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Biochemical, Physiological, and
Molecular Aspects of Human
Nutrition

FOURTH EDITION

Martha H. Stipanuk, PhD

Professor, Division of Nutritional Sciences, Colleges of Human Ecology
and, Agriculture and Life Sciences, Cornell University, Ithaca, New
York

Marie A. Caudill, PhD, RD

Professor, Division of Nutritional Sciences, Colleges of Human Ecology
and, Agriculture and Life Sciences, Cornell University, Ithaca, New
York
Table of Contents

Cover image

Title page

Copyright

Contributors

Reviewers

Preface

Acknowledgments
UNIT I. Nutrients

Chapter 1. Nutrients: History and Definitions

Discovery of the Nutrients

Setting Criteria for Essentiality

Conditionally Essential Nutrients

Shift From Focus on Prevention of Deficiency Diseases to Providing Nutrients for

Maintenance of Good Health

Recognition of Health Benefits of Nonnutrient Components of Food or of Higher

Intakes of Nutrient Components of Food

Personalized Nutrition

Rise of the Supplement and Functional Food Industries

 Thinking Critically—End of Chapter

Chapter 2. Guidelines for Food and Nutrient Intake

Dietary Reference Intakes

Dietary Advice: Goals, Guidelines, and Food Guides

Food and Supplement Labels and Other Nutrition Information

Thinking Critically—End of Chapter

UNIT II. Structure and Properties of the

Macronutrients

Chapter 3. Structure, Nomenclature, and Properties of

Carbohydrates
Monosaccharides

Glycosidic Linkages, Glycosides, and Polymerization of Sugar Residues

Common Disaccharides and Oligosaccharides

Polysaccharides

Conjugates of Carbohydrates and Proteins or Lipids

Thinking Critically—End of Chapter

Chapter 4. Structure, Nomenclature, and Properties of Lipids

Fatty Acids

Glycerolipids

Sphingolipids

Other Lipids with Linked Fatty Acids—Esters, Thioesters, and Amides

Isoprenoids and Steroids

Oxidized Derivatives of Fatty Acids

Amphipathic Lipids at Water–Lipid Interfaces

Lipid Autoxidation of Pufas

 Thinking Critically — End of Chapter

Chapter 5. Structure, Nomenclature, and Properties of Proteins

and Amino Acids
The Proteinogenic Amino Acids

Synthesis of Peptides and Proteins

Protein Structure

Posttranslational Modifications of Proteins

Trafficking of Proteins to their Destinations

Regulation of the Amount of Protein and its Functional State

Classification of Proteins

Synthesis of Small Peptides or Isopeptide Linkages Without Involvement of the

Genetic Code or Ribosomes

Important Food Proteins: Nutritional and Functional Aspects

Thinking Critically—End of Chapter

UNIT III. Digestion and Absorption of the

Macronutrients

Chapter 6. Overview of Digestion and Absorption

General Structure and Function of the Gastrointestinal Tract

The Upper Gastrointestinal System

The Small Intestine

The Large Intestine

General Mechanisms for Regulation of Gi Tract Function

Thinking Critically—End of Chapter

Chapter 7. Digestion and Absorption of Carbohydrate

Overview of Digestion and Absorption of Carbohydrates
 Digestion of Available Carbohydrates to Monosaccharides and Absorption of the
Monosaccharides

Regulation of Postprandial Glycemia

Fate of Nondigestible Oligosaccharides and Nonstarch Polysaccharides in the

Large Intestine

Thinking Critically—Clinical Correlation Box—Glucose And Galactose

Malabsorption

Thinking Critically—CLinical Correlation Box—Diabetes Mellitus

Thinking Critically—Nutrition Insight Box—Prebiotics or Probiotics or Both

Thinking Critically—Clinical Correlation Box—Short-Bowel Patients

Thinking Critically—End of Chapter

Chapter 8. Digestion and Absorption of Lipids

Overview of Digestion and Absorption of Lipids

Digestion of Lipids

Absorption of Lipid Digestion Products by Enterocytes

Intracellular Metabolism and Secretion of Absorbed Lipid Digestion Products by

Enterocytes

Portal Transport of Fatty Acids

Dietary Lipid Sensing and Signaling Functions in the Gut And Brain–Gut Axis

Thinking Critically — End of Chapter

Chapter 9. Digestion and Absorption of Protein

Overview of Protein Digestion and Absorption

Digestion of Protein in the Gastrointestinal Tract

Absorption of Free Amino Acids and Small Peptides

Antigen Sampling and Bioactive Peptides

Fate of Undigested Protein or Unabsorbed Peptides and Amino Acids

Determining Dietary Protein Digestibility

Thinking Critically—Nutrition Insight Box—Trypsin Inhibitors

 Thinking Critically—Clinical Correlation Box—Cystinuria

Thinking Critically—Clinical Correlation Box—Celiac Disease: Gluten-Sensitive

Enteropathy

Thinking Critically—End of Chapter

UNIT IV. Metabolism of the Macronutrients

Chapter 10. Central Aspects of Macronutrient Metabolism

Central Role of ATP and NADPH in Coupling Fuel Catabolism to Performance of
Anabolic/Chemical, Electrogenic, and Mechanical Work

Overview of Fuel Catabolism

The Oxidative Decarboxylation of Pyruvate, the Citric Acid Cycle, the Electron
Transport Chain, and Oxidative Phosphorylation

ATP Synthesis: The Mitochondrial Electron Transport Chain and Oxidative

Phosphorylation

Reactions Involved in the Reduction of NADP to NADPH

Counting Energy Costs Using ATP Equivalents

Amphibolic Roles of Central Pathways of Metabolism

Thinking Critically—Nutrition Insight Box—Alcohol: Calories and Concerns

Thinking Critically—End of Chapter

Chapter 11. Overview of the Regulation of Macronutrient

Metabolism
Metabolism Includes Both Catabolism and Anabolism

Regulation of Macronutrient Metabolism at the Whole-Body Level

Regulation of Macronutrient Metabolism at the Tissue Level

Macronutrient Metabolism at the Cellular Level

Regulation of Macronutrient Metabolism at the Cellular Level

Integrative Pathways for Regulation of Macronutrient Metabolism at the Cellular

Level

Thinking Critically – End of Chapter

Chapter 12. Metabolism of Carbohydrate
Cellular Uptake and Metabolism of Glucose

Glucose Utilization: Glycolysis

Metabolism of Monosaccharides other than Glucose

Glucose Utilization: Glycogen Synthesis from Glucose

Other Pathways of Glucose Utilization

Glucose Production: Glycogen Degradation

Glucose Production: Gluconeogenesis

Other Pathways of Carbohydrate Metabolism; Synthesis of other Sugars and Sugar

Derivatives, Glucuronides, Lactose, Glycoproteins, and Glycolipids

Thinking Critically—Clinical Correlation Box—Hereditary Fructose Intolerance and

Essential Fructosuria

Thinking Critically—Clinical Correlation Box—Glycogen Synthase Deficiency

Thinking Critically—Clinical Correlation Box—Glucose 6-Phosphatase Deficiency

Thinking Critically—End of Chapter

Chapter 13. Metabolism of Fatty Acids, Acylglycerols, and

Sphingolipids
Fatty Acid and Triacylglycerol Metabolism

β-Oxidation of Fatty Acids

Formation of Ketone Bodies from Acetyl-CoA in the Liver as a Fuel for Extrahepatic
Tissues

De Novo Synthesis of Fatty Acids from Acetyl-CoA

Synthesis of C20 and C22 Polyunsaturated Fatty Acids from Dietary Precursors

Synthesis of Triacylglycerols

Synthesis, Secretion, and Metabolism of Triacylglycerol-Rich Lipoproteins

Mobilization of Stored Triacylglycerols

Phospholipids

Ether-Linked Glycerophospholipids

Sphingolipids
 Proteolipids

Thinking Critically—Nutrition Insight BOX—The Carnitine Shuttle in Reverse

Thinking Critically—Clinical Correlation Box—Deficiencies in Beta-Oxidation

Thinking Critically—Clinical Correlation Box—Essential Fatty Acid Deficiency

Thinking Critically—Nutrition Insight Box—Fatty Acid Remodeling

Thinking Critically—Clinical Correlation Box—Inborn Errors

Thinking Critically—End of Chapter

Chapter 14. Cholesterol and Lipoproteins: Synthesis, Transport,

and Metabolism
Overview of Cholesterol and Lipoprotein Metabolism

Cholesterol and Isoprenoid Synthesis and its Regulation

The Role of Apolipoprotein B–Containing Lipoproteins in the Delivery of Cholesterol

to Tissues

The Role of Apolipoprotein A-I‒Containing Lipoproteins in the Efflux of Cholesterol

and its Delivery to the Liver

Cellular Metabolism of Cholesterol

Secretion of Cholesterol and Bile Acids in the Bile and their Enterohepatic
Reabsorption and Net Fecal Excretion

Role of Lipids in the Development of Atherosclerosis

Thinking Critically—Nutrition Insight Box—Switch-Like Control of SREBP2

Thinking Critically—Clinical Correlation Box—Apolipoprotein E Variants

Thinking Critically—Clinical Correlation Box—Nature Points to New Methods of

Lowering Cholesterol

Thinking Critically—Clinical Correlation Box—Tangier Disease

Thinking Critically—End of Chapter

Chapter 15. Protein and Amino Acid Metabolism

Overview

Amino Acid Transport in and Out of Cells

 Synthesis of Semi-Essential and Essential Amino Acids

Movement of Amino Groups from One Carbon Skeleton to Another

Protein Turnover

Use of Amino Acids for Protein Synthesis

Posttranslational Modification and Translocation or Trafficking of Newly Synthesized

Proteins

Protein Degradation

Use of Amino Acids for Synthesis of Nonprotein Nitrogenous Compounds and

Sulfur-Containing Compounds

Amino Acid Catabolism, Gluconeogenesis, and Excretion of Nitrogen

Changes in Protein Metabolism in Response to Growth, Undernutrition, Physical

Activity, and Hypermetabolic Catabolic Stresses

Thinking Critically – End of Chapter

Chapter 16. Metabolism of Individual Amino Acids

Metabolism of the Nonessential Amino Acids

Essential and Semi-Essential Amino Acids

Thinking Critically—Clinical Correlation Box—Glutamate Dehydrogenase and the

Hyperinsulinism/Hyperammonemia Syndrome

Thinking Critically—Clinical Correlation Box—Modification of Amino Acid Intake to

Treat Genetic Disorders of Amino Acid Metabolism

Thinking Critically—End of Chapter

UNIT V. Macronutrient Requirements

Chapter 17. Total Energy Requirement: Energy Expenditure,

Growth, and Energy Stores
Energy, Heat, and Work

Energy Expenditure

Whole-Body Energy Expenditure

Use of Macronutrients as Substrates for Growth and Maintenance

Use of Macronutrients as Substrates for Energy Stores

 Roles of White and Brown Adipose Tissues in Energy Storage and Energy
Expenditure

Estimates of Total Energy Requirements and Physiological Energy Values of Foods

Energy Balance and Regulation of Energy Intake and Energy Expenditure

Thinking Critically—Clinical Correlation Box—Congenital Leptin Deficiency

Thinking Critically–End of Chapter

Chapter 18. Requirements or Recommended Intakes for

Carbohydrates and Lipids
Typical Intakes of Carbohydrates and Lipids

Recommendations for Amount and Type of Carbohydrate in the Diet

Essentiality of n−3 And n−6 Polyunsaturated Fatty Acids (PUFAs)

Recommendations for Amount and Type of Lipids in the Diet

Thinking Critically—Nutrition Insight Box—How Much Added Sugar Do You

Consume?

Thinking Critically—End of Chapter

Chapter 19. Protein and Amino Acid Requirements

Classification of Dietary Essential and Nonessential Amino Acids

Requirements for Dietary Protein

Requirements for Individual Amino Acids

Protein Quality: Amino Acid Composition of the Protein and the Digestibility,
Absorbability, and Utilizability of the Amino Acids in the Protein

Typical Intakes of Protein and Amino Acids and Significance of Protein/Energy

Ratios

Effects of Inadequate Protein Intake and Assessment of Protein Status

How Much Protein is too Much Protein?

Other Factors for Consideration in Making Recommendations for Amino Acid and
Protein Intake

Thinking Critically—End of Chapter

Chapter 20. Consequences of Energy Imbalance: Obesity and
Undernutrition
Consequences of Excess Energy Intake: Overweight and Obesity

Metabolic Syndrome

Consequences of Inadequate Energy Intake: Protein-Energy Malnutrition and

Starvation

Undernutrition Owing to Increased Energy Expenditure: Hypermetabolic States

Thinking Critically—End of Chapter

UNIT VI. The Vitamins

Chapter 21. Niacin, Riboflavin, and Thiamin

Niacin

Niacin and Pyridine Nucleotide Coenzyme Structure and Nomenclature

Sources, Digestion, and Absorption

Niacin and Tryptophan Metabolism to NAD Coenzymes

Niacin Catabolism and Excretion

Functions of Pyridine Nucleotide Coenzymes in Metabolism

Noncoenzymatic Functions of Niacin

Health Effects of Niacin

Niacin-Responsive Genetic Disorders

Dietary Recommendations, Intake, and Assessment

Toxicity

Riboflavin

Structure, Nomenclature, and Chemistry

Riboflavin Sources, Digestion, Absorption, and Excretion

Conversion of Riboflavin to Coenzymes

Functions of Flavocoenzymes in Metabolism

Health Effects of Riboflavin

Riboflavin-Responsive Genetic Disorders

 Dietary Recommendations, Intake, Assessment, and Toxicity

Thiamin

Thiamin and Thiamin Coenzyme Structure and Nomenclature

Food Sources, Digestion, Absorption, and Transport

Conversion of Thiamin to Coenzyme Form

Functions of Coenzymatic Thiamin in Metabolism

Health Effects of Thiamin

Thiamin-Responsive Genetic Disorders

Dietary Recommendations, Intake, Assessment, and Toxicity

Interdependence of B3, B2, and B1

Thinking Critically—Clinical Correlation Box—Case Study of Pellagra in an Adult

Woman

Thinking Critically—Clinical Correlation Box—Multiple Acyl-CoA Dehydrogenase

Disorders and Riboflavin

Thinking Critically—Clinical Correlation Box—Infantile Thiamine Deficiency in

Industrialized Nations

Thinking Critically—End of Chapter

Chapter 22. Folate, Choline, Vitamin B12, and Vitamin B6

Folate

Nomenclature and Structure

Food Sources of Folate

Absorption Of Folate

Bioavailability of Folate

Tissue Uptake and Transport

Excretion

Metabolism and Biological Functions of Folate

Health Effects

Folate Dietary Recommendations

Folate Intake
Assessment and Status Indicators

Choline

Nomenclature and Structure

Food sources

Digestion and Absorption of Choline

Bioavailablity of Choline

Tissue Uptake of Choline

Metabolism of Choline

Excretion of Choline

Biological Functions

Choline Deficiency

Health Effects

Dietary Recommendations for Choline

Factors Affecting Choline Requirements

Dietary Intake of Choline

Assessment and Status Indicators

Toxicity

Vitamin B12

Nomenclature and Structure

Food Sources

Digestion of Vitamin B12

Absorption of Vitamin B12

Bioavailability of Vitamin B12

Transport, Tissue Uptake, Metabolism, and Excretion

Biological Functions of Vitamin B12

Vitamin B12 Deficiency

Dietary Recommendations and Intake

Assessment of Vitamin B12

 Vitamin B6

Nomenclature and Structure

Food Sources

Digestion and Absorption

Bioavailablity

Metabolism of Vitamin B6

Distribution

Storage and Turnover

Biological Functions

Vitamin B6 Deficiency

Health Effects

Dietary Recommendations

Vitamin B6 Intake

Assessment and Status Indicators

Toxicity

Thinking Critically—End of Chapter

Chapter 23. Biotin and Pantothenic Acid

Biotin

Nomenclature and Structure

Food Sources, Digestion, and Absorption

Synthesis of Biotin-Containing Carboxylases (Holoenzymes) and Their Mechanism

of Action

Functions of Biotin-Dependent Carboxylases in Metabolism

Biotin and Gene Regulation

Biotin Catabolism and Excretion

Health Effects Of Biotin

Inborn Errors of Biotin Metabolism

Dietary Recommendations, Intake, and Assessment

 Pantothenic Acid

Nomenclature and Structure

Dietary Sources, Digestion, Tissue Uptake, and Excretion

Metabolism of Pantothenic Acid to CoA and ACP

Biological Functions of CoA and ACP

Health Effects of Pantothenic Acid

Dietary Recommendations, Intake, and Toxicity

Thinking Critically—End of Chapter

Chapter 24. Vitamin C

Nomenclature, Structure, and Chemical Properties

Vitamin C Synthesis

Dietary Sources

Supplemental Sources

Intestinal Absorption

Tissue Distribution

Transport of Vitamin C

Enzymatic Functions of Vitamin C

Dioxygenases

Other Enzymes

Nonenzymatic Functions of Vitamin C

Vitamin C Deficiency: Scurvy

Vitamin C in Disease Prevention

Vitamin C in Disease Treatment

Dietary Recommendations and Status Assessment

Vitamin C Intake in the United States

Toxicity

Thinking Critically—End of Chapter

Chapter 25. Vitamin K
Nomenclature and Structure of Vitamin K

Food Sources, Digestion, and Absorption

Tissue Uptake, Metabolism, Transport, and Excretion

Biological Functions of Vitamin K

Vitamin K Antagonists and Clinical Uses

Health Effects of Vitamin K

Dietary Recommendations for Vitamin K

Vitamin K Deficiency

Assessment of Vitamin K Status

Thinking Critically—Clinical Correlation Box—Warfarin and Pharmacogenetics

Chapter 26. Vitamin E

Nomenclature and Structure of Vitamin E

Food Sources, Digestion, and Absorption

Transport and Tissue Uptake

Hepatic Export and Metabolism of Vitamin E

Biological Functions of Vitamin E

Health Effects of Vitamin E

Dietary Recommendations For Vitamin E

Dietary Intake of Vitamin E

Status Indicators

Toxicity of Vitamin E

Thinking Critically—Nutrition Insight Box—Vitamin E Requirement in Relation to

Polyunsaturated Fatty Acid Intake

Thinking Critically—Clinical Correlation Box—Familial Isolated Vitamin E Deficiency

and α-Tocopherol Transfer Protein

Thinking Critically—End of Chapter

Chapter 27. Vitamin A
Nomenclature, Structure, and Chemical Properties

Food Sources of VITAMIN A

Digestion and Absorption

Hepatic Metabolism, Export, Transport, and Excretion

Extrahepatic Metabolism of Vitamin A

Intracellular Vitamin A–Binding Proteins

Physiological Functions of Vitamin A

Extranuclear and Nontranscriptional Effects

Health Effects Of Vitamin A

Dietary Recommendations and Intake

Assessment and Status Indicators

Toxicity

Thinking Critically—End of Chapter

Chapter 28. Vitamin D

Nomenclature and Structure

Endogenous Synthesis

Food Sources and Absorption

Metabolism of Vitamin D

Classic Endocrine Functions of Vitamin D

Molecular Actions of Vitamin D

Vitamin D and Health Outcomes

Dietary Recommendations and Intake

Assessment of Vitamin D Status

Toxicity

Thinking Critically—Clinical Correlation Box—Vitamin D–Dependent Rickets Type II

Thinking Critically—End of Chapter

UNIT VII. The Minerals

Chapter 29. Calcium and Phosphorus

Chemistry

Food Sources

Bioavailablity

Intestinal Absorption

Excretion

Non-Skeletal Functions

Calcium and Phosphorus as Components of Mineralized Tissue

Regulation of Calcium and Phosphorus Homeostasis

Health Effects

Medications that May Interfere with Calcium or Phosphate Homeostasis

Dietary Recommendations

Dietary Intake

Assessment and Status Indicators

Toxicity

Thinking Critically—End of Chapter

Chapter 30. Magnesium

Chemistry of Magnesium

Food Sources

Absorption

Magnesium Distribution, Transport, and Excretion

Physiological Roles of Magnesium

Health Effects of Magnesium

Magnesium Deficiency

Recommended Dietary Allowances

 Dietary Intake of Magnesium

Magnesium Toxicity

Thinking Critically—Clinical Correlation Box—Magnesium Depletion in Patients With

Diabetes Mellitus

Thinking Critically—Clinical Correlation Box—Magnesium Deficiency in Chronic

Alcohol Abuse

Chapter 31. Sodium, Chloride, and Potassium

Chemistry

Food Sources

Absorption

Distribution and Compartmentation

Regulation of Sodium, Chloride, and Potassium Balance

Sodium and Chloride Imbalances and their Consequences

Potassium Imbalance and its Consequences

Biological Functions

Chronic Disease Risk

Recommendations and Intake

Thinking Critically—Clinical Correlation Box—Hypertension Genetics: High and Low

Penetrance

Thinking Critically—Clinical Correlation Box—Diarrhea

Thinking Critically—End of Chapter

Chapter 32. Body Fluids and Water Balance

Physiological Functions of Water

Body Water Content And Forces Governing Its Distribution

Forces Determining The Distribution Of Water Between The Intracellular And

Extracellular Fluid Compartments

Water Balance

Renal Mechanisms For Regulating Loss Of Water In Urine

 Regulation of Water Balance

Water Imbalance and Its Consequences

Thinking Critically—Clinical Correlation Box—Heat Acclimatization

Thinking Critically—Clinical Correlation Box—Edema Formation

Chapter 33. Iron

Chemistry of Iron

Proteins Involved in Iron Transport, Storage, and Recycling

Food Sources of Iron

Absorption of Iron

Regulation of Iron Absorption

Cellular Iron Uptake and Export

Intracellular Iron Trafficking, Role of Mitochondria in Heme and Iron-Sulfur Cluster

Cofactor Synthesis, and Intracellular Iron Storage

Biological Functions of Iron

Body Iron Compartments and Daily Iron Exchange

Regulation of Cellular Iron Homeostasis

Systemic Iron Homeostasis

Body Iron Balance

Health Effects: Iron Deficiency

Health Effects: Iron Overload

Dietary Recommendations and Intake

Laboratory Evaluation of Iron Status

Thinking Critically—Clinical Correlation Box—Iron Overload

Chapter 34. Zinc, Copper, and Manganese

Chemistry

Food Sources

Absorption
 Tissue Uptake, Metabolism, and Transport

Storage

Excretion

Biological Functions

Health Effects

Dietary Recommendations and Intake

Assessment and Status Indicators

Toxicity

Thinking Critically—Clinical Correlation Box—Genetic Disturbances in Copper

Metabolism

Thinking Critically—Clinical Correlation Box—The Role of Ceruloplasmin in Iron

Metabolism

Chapter 35. Iodine

Chemistry Of Iodine

Sources of Iodine

Absorption, Storage, and Excretion

Thyroid Hormone Synthesis, Metabolism, and Transport

Activation and Deactivation of Thyroid Hormones

Regulation of Thyroid Hormone Status

Mechanism of Action of Thyroid Hormones

Nonnuclear Pathways

Physiological Functions of Thyroid Hormones

Iodine Deficiency

Effects of Iodine Excess

Dietary Recommendations for Iodine

Dietary Intake

Toxicity

Thinking Critically—End of Chapter

Chapter 36. Selenium
Chemistry of Selenium

Food Sources and Absorption

Tissue Uptake and Distribution

Metabolism OF Selenium

Excretion

Biological Functions

Health Effects

Dietary Recommendations and Intake

Status Indicators and Assessment

Toxicity

Thinking Critically—End of Chapter

Chapter 37. Fluoride

Chemistry of Fluoride

Sources and Absorption

Fluoride Metabolism and Excretion

Health Effects of Fluoride

Dietary Recommendations For Fluoride

Fluoride Intake

Toxicity

Thinking Critically—End of Chapter

Chapter 38. Molybdenum and the Beneficial Bioactive Trace

Elements
Molybdenum

Food Sources

Absorption
Transport and Excretion

Metabolism

Biological Functions

Health Effects

Dietary Recommendations and Intake

Assessment and Status Indicators

Toxicity

Boron

Food Sources

Absorption

Tissue Uptake, Metabolism, Transport, and Excretion

Biological Functions

Health Effects

Dietary Considerations

Assessment and Status Indicators

Toxicity

Chromium

Food Sources and Absorption

Tissue Uptake, Transport, and Excretion

Biological Functions

Health Effects

Dietary Recommendations and Intake

Assessment and Status Indicators

Toxicity

Silicon

Food Sources and Absorption

Tissue Uptake, Distribution, Transport, and Excretion

Biological Functions
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